Introduction

More than 18% of the United States (U.S.) population is Latinx and by 2050, it is expected to be 30% (Martínez & Rhodes, 2020). The majority of U.S. Latinx identify as Mexican (62.3%), with Puerto Rican and Central Americans being the second highest representation (Martínez & Rhodes, 2020). Latinx subgroups in the U.S. experience health disparities that are caused by social determinants of health: low socioeconomical status and educational attainment, racial and ethnic discrimination, cultural and linguistic gaps, immigration and/or documentation status, acculturation, and postmigration distress. Compared with other ethnic/racial and socioeconomic groups, the U.S. Latinx population is disproportionately affected by chronic diseases, with cancer being the leading cause of death (Baquero & Parra-Medina, 2020; Marshall et al., 2018).

One of the social determinants overlooked in Latinx cancer disparities is the impact of cancer on and of family dynamics. Cancer affects the family as a whole and can lead to ripple effects across generations (Bowen, 1978). Psycho-oncology is an emerging field from oncology whose focus is on psychological dimensions of the experience of cancer and psychosocial interventions (Weiss Wiesel et al., 2015). Psychosocial interventions have a wide range in terms of modality (individual, group-based, educational workshops, family-based) and outcome focus (individual family member measures vs family measures). Some family-based interventions address families in different stages of functioning, such as supportive interviews for healthy functioning families, psychoeducational guidance for families adapting but facing communication issues, and therapeutic interviews for dysfunctional families in crisis (Magnen-Desdouits & Flahault, 2012). From a psycho-oncology lens, the treatment of Latinx families with cancer patients would benefit from culturally tailored family-based interventions.

Psychosocial interventions from health care professionals (family medicine physicians, nurses) and mental health professionals have been proven to be effective with cancer patients and their families (Azcárate-Cenoz et al., 2026; Vélez Agosto, 2025; Hodgson et al., 2011). Despite their documented effectiveness, family therapy-based interventions are not as popular as individual interventions for cancer patients and their family members or caregivers (Azcárate-Cenoz et al., 2026; Hodgson et al., 2012; Lamson et al., 2022; Niemelä et al., 2016; Shields et al., 2012). The primary issue is that most psychosocial interventions have been developed to focus on the individual, or have a dyadic focus (patients and caregivers, or patients and children), but not family-based or family systems focused (Hodgson et al., 2011; Lamson et al., 2022). Dyadic-focused interventions are those that include a pair of family members, such as patient and caregiver, patients and children, or patient and partner, while family-focused include all members of the family, such as parents and children, the couple included as a unit, the couple with extended family members, and/or caregivers. Systemic family-based psychosocial interventions are those that focus on couple and/or family-based relational processes or interactions (Hodgson et al., 2011; Lamson et al., 2022). While both dyadic and family-based could be conceptualized within a similar theoretical lens, it’s not always the case and instead the intervention focus is designated as family with a “sum of all parts” approach or just by inclusion of members only (Hodgson et al., 2011). Therefore, few family-based interventions are systemic-oriented, incorporating systems theory in all phases of the intervention, such as intervention design, components, and measurement.

Past Reviews and Cancer Psychosocial Intervention Research Gaps

While previous systematic reviews and meta-analyses have documented benefits of addressing systemic components in interventions (Becqué et al., 2023; Bu et al., 2025; Hodgson et al., 2011; Kissane et al., 2016; Lamson et al., 2022; Niemelä et al., 2016), they have also pointed out relevant gaps in research. Lamson et al. (2022) found a significant gap in research that includes minoritized couples and families. Niemelä et al. (2016) highlighted a gap in research concerning the study of children when families face a life-threatening parental illness, describing the children as a “forgotten group” in the research literature. This suggests the relevance of including systemic perspectives in the study of underserved populations, such as Latinx cancer survivors and their families.

The following systematic reviews have addressed family psychosocial interventions for cancer in Latinx populations (Guan et al., 2023; Llave et al., 2024). Guan et al. (2023) reviewed family-based psychosocial intervention studies focused on adult Latino patients with cancer and their caregivers. They found that U.S.-based interventions included cultural considerations, such as including Latino values and beliefs and the use of bilingual, and bicultural interventionists. Findings suggested that Latino’s sociocultural values have compelled a diverse range of family members into the caregiver role: spouses/partners, children, parents, siblings, friends, and others, which supports the importance of familismo. Llave et al. (2024) did a review of psychosocial and behavioral interventions that incorporate culture to examine their benefit in underserved populations with advanced and metastatic cancer. Among the studies that focused on Latinx populations, they found that cultural norms influenced when to engage respectfully or what topics to bring up when communicating with health care providers. They also distinguished how, when participating in digitally adapted interventions, Latino/a participants did not have access to digital technologies or did not know how to use them. Overall, these findings suggest the importance including both cultural and systemic dimensions to psychosocial interventions addressing cancer in Latinx families.

Significance (Present Review)

Currently, there are no critical reviews addressing cancer psychosocial intervention research with both a systems theory and cultural lens to better inform intervention design and research for Latinx populations impacted by cancer. Latinx populations are heterogeneous due to representing a multilingual, multiracial, and multinational group of people. The use of the Latinx identifier is inclusive and used to emphasize the differences that exist among subgroups (Martínez & Rhodes, 2020). This doesn’t mean that interventions should not consider differences between groups and treat Latinx people as monolithic. Adopting a cultural microsystems approach means that intervention design and research would benefit from considering the meaning-making process of culture in systems and tailoring accordingly (Vélez-Agosto et al., 2017). Together, systems theory and cultural gaps in psychosocial interventions leave out important questions about how systems components are defined and operationalized in intervention design and research, as well as how culture is conceptualized and included. Based on these theoretical gaps, the present critical review addresses the following guiding questions for the studies selected:

1. To what extent do existing psychosocial interventions for families affected by cancer incorporate core principles of family systems theory (e.g., interdependence, communication, cohesion, adaptation, and systemic outcomes)?
2. How frequently are these interventions truly family-based (i.e., involving multiple family members in intervention delivery and assessing systemic/family-level outcomes) rather than individual, dyadic, or group-based?
3. What cultural adaptations, if any, have been implemented in these interventions to align with Latinx values (such as familismo, respeto, and spirituality) and address relevant social determinants (e.g., acculturation stress, language barriers, discrimination)?
4. What key strengths, limitations, and gaps in the current evidence base can inform the future design of culturally tailored, systems-oriented family psychosocial interventions for Latinx families impacted by cancer?

To set the conceptual and empirical background of the review, the following sections expand on social determinants, system components, and cultural considerations addressed in scientific literature that are relevant to Latinx cancer psychosocial intervention design and research.

Social Determinants of Health of Latinx Families With a Cancer Patient

Most of what is known about cancer’s impact on the Latinx family relates to barriers for treatment, such as lack of health insurance, poverty, and English-language proficiency (Casillas et al., 2021; Kronenfeld et al., 2021; Martínez, 2020; Zubler et al., 2025). For example, socioeconomic status leads to significant barriers to Latinx health care, such as lack of transportation, long waits, inflexible hours, distance between home and treatment location, lack of health insurance, and cost. Socioeconomic status is also linked with stressors related to neighborhood violence and food insecurity that can impact the ability of Latinx individuals to remain physically active and to exercise outside, as well as access to nutritious food resulting in nutritional deficiencies (Kronenfeld et al., 2021). Very little research has documented how socioeconomic status impacts family functioning when there is a cancer patient. For example, cancer can disrupt and create new routines for family members (e.g., stopping work and making time for medical appointments) (Vélez Agosto, 2025; Phillips & Prezio, 2017; Santos et al., 2018). Therefore, families’ daily routines, roles, and responsibilities undergo major shifts to accommodate the demands of cancer treatment.

Latinx immigrants face additional challenges to optimal end-of-lifecare. These include geographic distance and contextual realities that often separate patients from their families (Ko et al., 2023; Smith et al., 2009); fear of deportation if undocumented; language and literacy barriers; concerns about discrimination (Smith et al., 2009); and acculturative stress (Benuto & O’Donohue, 2016). In addition, Latinx cancer patients who live near the U.S.–Mexico border region may experience complex coordination of care, physical distance to treatment facilities, and health insurance comparability between the two nations (Castañeda et al., 2015; Ko et al., 2023). This also leads to undocumented immigrants presenting more advanced-stage diseases (Kronenfeld et al., 2021), such as breast cancer (Cabral & Cuevas, 2020). Therefore, it impacts families’ access to health services and treatment adherence (Kronenfeld et al., 2021) and translates to family-systemic challenges. For example, family members develop mental health symptoms due to concerns about the undocumented status of other family members (Benuto & O’Donohue, 2016).

Mental Health and Acculturative Stress in Latinx Families With a Cancer Patient

Regarding mental health, Latinx communities experience high rates of depression and anxiety, with U.S.-born Latinx rates being higher than rates for foreign-born Latinx (Benuto & O’Donohue, 2016). Acculturation is a multi-dimensional process of change in cultural attitudes and behaviors as a result of an encounter between two cultures (Bekteshi & Kang, 2020; Berry, 1997). Negative associations related to acculturation are conceptualized as acculturative stress and postmigration distress, emphasizing the psychological difficulty following immigration, accounting for well-being and coping (Walsh et al., 2008). Acculturative stress and postmigration distress have been linked to different types of poor mental health symptoms, such as depression, personality disorders, decreased neurocognitive function, and posttraumatic stress (Bekteshi & Kang, 2020; Kronenfeld et al., 2021). This can also explain why Latinx cancer survivors report worse psychological, physical, and social well-being compared with other racial/ethnic groups (Ramirez & Magasi, 2025).

Acculturative stressors impact family functioning, although few studies have focused on cancer and mental health outcomes among Latinx families (Slaughter et al., 2022). From a Family Systems Theory and Bicultural Family Functioning approach, Slaughter et al. (2022) examined the role of acculturation discrepancy on Hispanic Childhood Cancer Survivors (HCCS) mental health and parent–child mental health. They found that Hispanic and Anglo-American acculturation was associated with lower depressive symptoms, greater posttraumatic growth, and higher child quality of life. Therefore, it is suggested that strong cultural identification may be beneficial for HCCS, while higher discrepancy between parent and child acculturation was related to negative psychosocial outcomes for the child. These type of conflicting results from acculturation processes are explained by examining the cultural values that Latinx and Mexican Americans from different generations uphold.

Latinx families in the U.S. endorse cultural values that serve as both protective and risk factors for psychological distress. In predominantly Mexican American population studies, cultural values identified as protective factors include “familismo” and spiritual beliefs or “espíritu” (Marín-Chollom & Revenson, 2022). Risk factors include stigma about mental health, “machismo” and “marianismo,” among others (Nuñez et al., 2016). Familismo refers to prioritizing immediate and extended family relationships with loyalty, respect, obligation, and support (Ramirez & Magasi, 2025). These cultural values are not monolithic, and they have been operationalized distinctively in research studies, but rarely within a systems lens or considering non-heteronormative family structures (Patrón, 2021). This risks the oversimplification of “endorsement” as the principal way they are studied in research, whereas a systemic lens would render a description of how they act as a process.

For example, endorsement of familism in Mexican American families has been related to better psychological adjustment in adult cancer patients and Latinx adolescents and young adults (Marín-Chollom & Revenson, 2022; Perez & Cruess, 2014). However, higher endorsement of familismo can also heighten stress appraisals (Marín-Chollom & Revenson, 2022) and may discourage patients from making positive behavioral changes that do not appear to benefit their family (Pedreira et al., 2024). From a systems lens, this may be due to how greater familismo signifies a closer relationship with the family, so greater stress is felt by the family member. Also, family conflict or lack of proximity to family networks can hinder the enactment of familism in cancer outcomes (Pedreira et al., 2024). Another limitation is that non-Latinx health care providers have conflicted views about familismo, identifying it as family overinvolvement and therefore a barrier to access to care (Moreno et al., 2023). All of these conflicting views about familismo can also point to limitations of researching “familismo” itself and outside of a theoretical lens.

Adopting a Systems-Theory and Cultural Lens Framework to Families With a Cancer Patient

Cancer affects families in and at systemic levels (Hodgson et al., 2011; Lamson et al., 2022; Shields et al., 2012; Slaughter et al., 2022; Zhou et al., 2025). Systems theory defines the family system as an interdependent and reciprocal unit that follows principles of natural systems such as being process-oriented, containing rules that guide members’ communication and behaviors, a tendency to conserve itself, while also being able to open and adapt to the environment. Research studies in psychosocial interventions for cancer have identified a need to address family systems on both intervention and outcomes (Bu et al., 2025; Costas-Muñiz et al., 2023; Llave et al., 2024; Shields et al., 2012; Thastum et al., 2006).

Cancer disrupts families structurally by family members role restructuring (e.g., adult children become caregivers) and functionally by emotional processes that increase psychological distress in family members and also increase psychological distress in others by their interrelationship (reciprocity in functioning). For example, parental cancer is a chronic stressor that disrupts psychosocial well-being from early childhood through young adulthood (Marín-Chollom & Revenson, 2022). Psychosocial distress from parental cancer includes depressive and anxiety symptoms, behavioral and emotional problems, stress responses, and lowered quality of life (Marín-Chollom & Revenson, 2022; Park et al., 2022). Parent and child dynamics are also impacted by acculturation and cancer when it comes to childhood cancer survivors (HCCS), particularly when there exist discrepancies in cultural values between generations (Slaughter et al., 2022). Also, couples often experience similar anxiety and depressive symptoms as the cancer patient (Manne & Ostroff, 2011). Cancer caregiving, in general, can have adverse effects on the psychosocial health of the family (Petursdottir et al., 2020).

Systems also account for communication patterns in families. Cancer can make families operate as closed systems, not sharing information with other members outside of the nuclear family or with each other. In a previous study of Puerto Rican families with a cancer patient (Vélez Agosto, 2025), it was shown that family members do not want to discuss cancer with the patient to “be strong” and not create additional burden on the patient. Also, parents struggle with how to explain serious illness and prognosis in a developmentally appropriate way to children and often weigh the benefits of sharing information against concerns about causing emotional harm (Park et al., 2022). Open communication about chronic illness has been proven beneficial in a lot of health outcomes for patients, including the sharing of cancer narratives (Park et al., 2022; Rosenbaum et al., 2006). Poor communication about illness-related subjects, on the other hand, can increase the risk for psychological distress in families affected by cancer. Therefore, parental distress has a negative impact on both parental psychological and physical health, as well as family functioning (Lövgren et al., 2022).

While systems theory accounts for the structural, functional, and adaptation of families, culture is the center. Culture provides the rules of the system, the context and the meaning-making activities on which families operate, create, and run routines, and relate to other systems (Vélez-Agosto et al., 2017). Understanding how family systems function within a cultural context is essential to working with Latinx families and cancer survivors (Guan et al., 2023; Llave et al., 2024; Marín-Chollom & Revenson, 2022; Rodas, 2025). For example, collectivist cultures cope using more internal psychological state modification strategies instead of directly addressing stressors (Marín-Chollom & Revenson, 2022). This trait can have an impact on family communicates about cancer or by exacerbating family emotional processes. Including family in care discussions and maintaining a focus on hope is beneficial for Latinx patients and caregivers due to their cultural dispositions toward optimism (Guan et al., 2023; Llave et al., 2024). Culture is the blueprint of family rituals (e.g., dinners, birthdays), and research has shown that family rituals change after a diagnosis of a chronic condition. Some families cancel rituals, while others may keep, readjust, or create new ones (Santos et al., 2018). Overall, integrating a cultural lens will provide a more comprehensive framework that validates systemic transformations of Latinx families with a cancer patient.

Method

This critical review intended to select exemplary articles to support its arguments by purposively selecting studies that illustrated family participation and cultural considerations in intervention design and delivery, and theoretical orientations aligned with systems theory. While it did employ some strategies that are typical of systematic reviews, its implementation was less rigorous, and selection bias is expected due to the research team’s judgment. The search for articles was conducted by the main author and two research assistants during the months of May 2025 through the last date searched in August 2025. The keywords used in the search were: psychosocial intervention, cancer, Latino, Latinx, cultural adaptation, culture, family systems, family-based. Four databases were searched—PsycINFO, PubMed, ProQuest, and Google Scholar—selected for their accessibility and relevance to psychosocial and health care research. Search terms were combined using Boolean operators, pairing intervention and population concepts; for example, (“psychosocial intervention” OR “family-based” OR “family systems”) AND (cancer) AND (Latino OR Latinx) AND (culture OR “cultural adaptation”). [Adjust this string to reflect what was actually run; note that Google Scholar was searched with simplified term combinations given its limited Boolean support.] Results were filtered to peer-reviewed articles published between 2015 and 2025 and to studies published in English.

The articles retrieved were organized in a table and were discussed in a team meeting to select the final nine from 11 studies extracted. This collaborative decision-making was intended to reduce reviewer bias. A qualitative summary was performed to compare and provide critique of participants included in the study, intervention components, theoretical framework of the intervention design, target outcomes, and findings. This review highlighted particularly how systems theory was addressed in intervention design or implementation and if the study intervention considered cultural components in both intervention design and implementation. Inclusion criteria for the studies were that they were family-based psychosocial interventions for cancer conducted in the last decade (2015–2025), and international and/or U.S.-based. The time criteria were chosen to give a more updated state in the direction of family-based intervention designs from Guan et al. (2023) and Hodgson et al. (2011) reviews. Eligible studies could be pilot, quasi-experimental, and clinical trials that were either quantitative or mixed-method designs. Given the limited number of rigorously evaluated, family-centered psychosocial interventions specifically designed for or tested with Latinx populations affected by cancer, this critical review includes a small set of high-quality studies conducted with non-Latinx samples (primarily from the United States, Europe, and Asia). These comparator studies were selected to illustrate established principles of systems-oriented family interventions (e.g., multi-family member involvement, systemic outcomes like family communication and adaptation) that could inform future culturally tailored adaptations for Latinx families. Although cultures vary in terms of values, geographical context, and history, the selected non-Latinx studies were considered due to their focus on the family as a unit. It’s an important systemic component conceptualized as familism in Latinx studies and consistent with Bowenian systems theory applications in Spanish-speaking countries (Rodríguez-González et al., 2016). The review, therefore, uses these examples as a foundation to highlight transferable strengths while underscoring persistent gaps in cultural alignment and Latinx representation.

Based on previous literature reviewed, the following criteria were considered in evaluating if a family-based psychosocial intervention for cancer was systems theory oriented: (a) family systems-oriented intervention design that addressed systems processes: functioning and adaptation and their embedded components (e.g., communication, cohesion, conflict, resources); (b) regarding participants, the intervention included more than one family member, such as the dyad patient–caregiver or patient and spouse/partner, as well as parents and children or patients and other family members (extended or family of origin); finally, (c) regarding evaluation, if the interventions measured systemic components such as family cohesion or communication, family functioning, or measured psychological distress of the family unit and/or all individual members. Criteria for cultural considerations included if the study mentioned the incorporation of cultural elements in intervention design or implementation and how.

Study Descriptions

The following section provides a description of study design, intervention characteristics, methodological critique, and a summary of outcomes and findings.

Study Characteristics

Of the nine studies selected for review, four were conducted in the U.S. (Casillas et al., 2021; Marshall et al., 2018; Park et al., 2022; Phillips & Prezio, 2017), one in China (Zhang et al., 2025), and the rest from different countries in Europe (Denmark, Sweden, the United Kingdom, Iceland) (Besani et al., 2018; Lövgren et al., 2022; Petursdottir et al., 2020; Salem et al., 2021). Two studies were quasi-experimental designs with posttest (Petursdottir et al., 2020; Zhang et al., 2025), three were pilot studies (Besani et al., 2018; Lövgren et al., 2022; Park et al., 2022), one was a randomized controlled trial (RCT) (Salem et al., 2021), another a pre-intervention and post-intervention evaluation design (Marshall et al., 2018), and one was a cross-sectional secondary analysis of data (Phillips & Prezio, 2017). Two of the studies also described the design as a single-arm trial with pre–posttest assessment (Casillas et al., 2021) and a single-group design with pre–posttest (Besani et al., 2018). All studies focused on more than one family member (patients, parents, caregivers, spouses, and siblings), with the exception of Petursdottir et al. (2020), who focused only on caregivers. Three of the studies were directed to cancer survivors and their adult caregivers (Marshall et al., 2018; Petursdottir et al., 2020; Zhang et al., 2025). Five studies were designed interventions for pediatric cancer patients that included at least one family member (parents and siblings) (Besani et al., 2018; Casillas et al., 2021; Lövgren et al., 2022; Park et al., 2022; Phillips & Prezio, 2017; Salem et al., 2021). Sample sizes range from 12 to 156 families intervened. See Table 1 for information and comparison of the selected studies.

Intervention Characteristics

All interventions primarily aimed to provide psychoeducation about various aspects of the cancer journey and to teach family communication and other coping skills. Interventions varied in how they facilitated engagement between the families, with few of them making it the focus (Besani et al., 2018; Casillas et al., 2021; Lövgren et al., 2022; Marshall et al., 2018; Phillips & Prezio, 2017; Salem et al., 2021). The conceptual frameworks of all the interventions varied, and the majority included systems theory approaches (Besani et al., 2018; Casillas et al., 2021; Lövgren et al., 2022; Marshall et al., 2018; Petursdottir et al., 2020; Phillips & Prezio, 2017; Salem et al., 2021), while others cognitive behavioral (Besani et al., 2018; Park et al., 2022; Salem et al., 2021), and other approaches (Besani et al., 2018; Lövgren et al., 2022; Marshall et al., 2018; Park et al., 2022; Zhang et al., 2025). The integration of a family systems approach varied between interventions. Some interventions are more closely aligned with systems theory principles, with main systemic components being part of the intervention (Park et al., 2022; Salem et al., 2021). The rest either neglected measuring all family members or did not include a systemic outcome or involve a systemic component as part of the intervention design. Also, not all interventions considered cultural characteristics or made explicit cultural considerations, except for both interventions aimed at Latinx (Casillas et al., 2021; Marshall et al., 2018). Casillas et al. (2021) incorporated a cultural component in the intervention design, using a photonovela that relies on storytelling, a way of communication common in Latino families. Marshalls et al. (2018) delivered interventions in English and Spanish, as well as used community settings for delivery and integrated the values of familism into the intervention. Both interventions therefore enhanced their systems orientation with the integration of cultural components. See Table 2 for intervention characteristics.

Delivery of interventions varied among the studies. Some studies used a web-based technology delivery (Park et al., 2022; Zhang et al., 2025), others face-to-face and phone call sessions that may have included traditional counseling/psychotherapy approaches, psychoeducational, and/or other types of meetings (Besani et al., 2018; Casillas et al., 2021; Lövgren et al., 2022; Marshall et al., 2018; Petursdottir et al., 2020; Phillips & Prezio, 2017; Salem et al., 2021). Only a few of the interventions were delivered by mental health professionals (Besani et al., 2018; Lövgren et al., 2022; Phillips & Prezio, 2017; Salem et al., 2021), while others were delivered by nurses, community health workers, or health advocates (Casillas et al., 2021; Marshall et al., 2018; Petursdottir et al., 2020). Sessions varied in length from 1-day workshops to seven sessions, ranging from 20 min to 2 hr.

Intervention Outcomes and Findings

Table 3 summarizes target outcomes, instruments, major findings, and methodological limitations of intervention studies. Psychological distress, coping, and abilities, as well as quality of life, were some of the major targets of interventions. Acceptability and feasibility were also among the targets of the intervention studies for pilot and pre–post intervention research design (Besani et al., 2018; Casillas et al., 2021; Lövgren et al., 2022; Marshall et al., 2018; Park et al., 2022; Zhang et al., 2025). Acceptability measures were either about satisfaction or treatment adherence and were researcher-developed for the intervention study.

The two interventions aimed at Latinx populations targeted an increase in cancer knowledge (Casillas et al., 2021; Marshall et al., 2018). Marshall et al. (2018) evaluated cancer knowledge with the 12-item Cancer Knowledge Questionnaire (CKQ) with no provided information about psychometrics. Casillas et al. (2021) measured intervention using a 57-item survey with good psychometric properties and previously used in another study that included six main conceptual domains related to “survivorship literature on a survivor’s knowledge regarding previous cancer treatment and treatment summaries, assessment of health status, and health care transitioning of adolescent and young adult survivors” (Casillas et al., 2011, p. 373), and two other study developed scales to measure cancer stigma and knowledge about the late effects and consistency in care. Psychometric properties of the survey were tested in diverse sample with only one-fourth of the participants considered ethnically diverse. In contrast, Park et al. (2022) targeted systemic outcomes, such as communication and family functioning. They included a measure of family functioning with good reliability, the McMaster Family Assessment Device–General Functioning Scale (GFS), and two measures for communication, one for self-efficacy, the Communication Self-Efficacy Scale (CSES), and one for parental communication of illness, the Parental Cancer Communication Questionnaire (PCCQ). All measures were filled out by one family member in the case of single families or both parents, but comparisons within and between families were not made.

In general, all interventions reported positive results in different outcomes within their study limitations. Interventions testing pilots found them feasible and had good participation rates (Besani et al., 2018; Casillas et al., 2021; Lövgren et al., 2022; Marshall et al., 2018; Park et al., 2022; Zhang et al., 2025). Reduction in PTSD, depression, and anxiety were found in interventions targeting psychological distress (Petursdottir et al., 2020; Salem et al., 2021). Intervention studies also showed improvement in systemic outcomes, such as communication and engagement (Casillas et al., 2021; Lövgren et al., 2021; Park et al., 2022; Phillips & Prezio, 2017). Despite these improvements in targeted outcomes, due to intervention design and measures, it’s difficult to differentiate improvement at the family functioning level, which requires not only the measure of systemic outcomes, but also measuring more than one member of the family.

Methodological Quality of the Studies

An appreciation of the multiple domains evaluated in the interventions point out the challenges of either measuring or incorporating systemic outcomes in data analysis. While studies mostly acknowledged common methodological limitations of intervention studies, such as small sample sizes (Casillas et al., 2021; Petursdottir et al., 2020; Zhang et al., 2025), lack of control group (Besani et al., 2018), and lack of diversity in sample, few recognized limitations regarding measuring systemic outcomes. For example, Phillips and Prezio (2017) described as a limitation that only one parent reported outcomes, recognizing the importance of collecting data from more than one member in the family. In contrast, Besani et al. (2018) reported that five of the families had 2 siblings reporting outcomes and therefore compromised the independence of cases in analysis. This inconsistency between the strengths and limitations of assessing more than one member per family could support the lack of theoretical fidelity to systems approaches in family-based intervention design. Most studies reviewed analyzed data per individual members, with only one study considering analysis at a dyadic and systemic level (Besani et al., 2018; Zhang et al., 2025). The two studies that included a cultural component to the intervention and delivery did not incorporate culturally adapted measures (Casillas et al., 2021; Marshall et al., 2018).

Including the Family: A Critical Examination of the Intervention Studies Within a Systems Theory and Cultural Lens

This section critically synthesizes the reviewed interventions in response to the four guiding questions, highlighting systemic fidelity, family-based elements, cultural alignment, and implications for many Latinx families focused research. While only two studies reviewed focused on some Latinx populations, the other studies provide partial support for the benefits of incorporating systems theory components to cancer psychosocial intervention design and research for populations where family functioning had been demonstrated as a social determinant of health.

1. To what extent do existing psychosocial interventions for families affected by cancer incorporate core principles of family systems theory (e.g., interdependence, communication, cohesion, adaptation, and systemic outcomes)?

Systemic components were present in all the studies reviewed, but their implementation varied in design and outcome focus. Identified systemic dimensions were either a theoretical concept, more than one family member or caregiver intervened on or measured, or systemic outcomes measured. Only some of the intervention studies named systems theory approaches explicitly in their conceptual frameworks (Besani et al., 2018; Marshall et al., 2018; Petursdottir et al., 2020; Phillips & Prezio, 2017; Salem et al., 2021). This reflects challenges in conceptualizing systems theory in psychosocial intervention design and research that might be related to variety in implementation of the many schools and psychotherapy models under systems theory.

Increasing family communication surrounding cancer was a salient component of most family-based interventions (Besani et al., 2018; Lövgren et al., 2022; Park et al., 2022; Phillips & Prezio, 2017; Salem et al., 2021). As discussed previously, increasing communication goes beyond individual change and aims to facilitate family adjustment/adaptation to cancer within a systems theory lens. But not all studies measured changes in communication as part of their outcomes, a significant limitation when evaluating systemic interventions.

Family engagement was an intervention aim in two studies (Casillas et al., 2021; Zhang et al., 2025), although they differed in how engagement was conceptualized and measured. In Zhang et al.’s (2025) study, participants were set up with interaction and sharing sessions across all four modules. Assignments were reviewed with researchers, and they also had to practice communication exercises in some of the modules. In Casillas et al.’s (2021) study, family members and survivors would read a script from the photonovela and answer discussion questions. Family engagement was captured qualitatively in Casillas et al.’s (2021) study, while it was not measured in Zhang et al.’s (2025). These are examples of how underlying conceptualizations of family engagement may lack epistemological correspondence with a specific systems theory model.

2. How frequently are these interventions truly family-based (i.e., involving multiple family members in intervention delivery and assessing systemic/family-level outcomes) rather than individual, dyadic, or group-based?

The evidenced presented in these studies do not support that interventions were truly family-based, with little agreement in what constituted a family intervention. For example, most studies that included systemic components in their interventions did not evaluate systemic changes in family functioning (adaptation, communication, or engagement) or corresponding intervention components. Only one study measured systemic outcomes (Park et al., 2022). Positively, all family members were measured for intervention-to-target outcomes in all studies, but family functioning within a systems theory lens, and as stated before, is more than the sum of its parts.

Taken together, these approaches to measure or not measure systemic components in interventions represent a research gap and limited theoretical precision. Very few instruments are designed to measure systemic outcomes, and of the ones that exist, they rely mostly on the report of just one family member (Platt & Skowron, 2013). Qualitative approaches that include either family observation, focus group approaches, and/or semi-structured interviews with all family members can help bridge the gap that quantitative outcomes have (Creswell & Plano Clark, 2018). They can also capture nuances in communication that survey research cannot, such as non-verbal language and family interaction (engagement).

3. What cultural adaptations, if any, have been implemented in these interventions to align with Latinx values (such as familismo, respeto, and spirituality) and address relevant social determinants (e.g., acculturation stress, language barriers, discrimination)?

Regarding psychosocial interventions designed for diverse populations, cultural considerations can enhance these outcomes, but the evidence is limited. Both studies that incorporated cultural considerations (Casillas et al., 2021; Marshall et al., 2018) were shown to be more accessible and adaptable to participants’ language and cultural values, reducing the access to services gap found in the literature of diverse populations in oncology (Kronenfeld et al., 2021). Despite this, cultural adaptations in research remain limited and superficial, representing a major gap for many Latinx families’ applicability.

4. What key strengths, limitations, and gaps in the current evidence base can inform the future design of culturally tailored, systems-oriented family psychosocial interventions for Latinx families impacted by cancer?

The limited evidence presented from this review showed a lot of strengths. Feasibility and acceptability were high in most studies. Systems theory-based approaches to intervention have demonstrated success in most outcomes studied. As summarized in Table 3, the reviewed interventions were generally feasible and acceptable, with notable improvements in areas such as parental PTSD/depression (Salem et al., 2021), family communication (Lövgren et al., 2022; Park et al., 2022), survivorship confidence (Casillas et al., 2021), and caregiver anxiety (Petursdottir et al., 2020). However, these do not represent exhaustive outcomes related to family functioning present in the psycho-oncology literature.

Limitations of the Critical Review and Evidence Presented

This critical review had several limitations. The studies selected represent a small evidence base, with only two that had Latinx populations. Therefore, interpretations should be made with caution. Also, the studies showed heterogeneity in how system theory components were included, with differences in the content of intervention, who delivered the intervention, intervention settings, and specific family members or caregivers targeted. These differences difficult comparisons across studies, limiting other review approaches, such as meta-analysis or meta-synthesis in the case of qualitative studies. In addition, outcomes reported were predominantly individual-level (e.g., parental depression, child coping) or proxy-reported (e.g., parent perceptions of child behavior). Measuring a family system should include measuring at least the nuclear portion of the system, taking into consideration the variations in how families defined themselves. Finally, few studies assess true family-system outcomes such as cohesion, adaptability, or intergenerational functioning. While these concepts are defined according to specific systems theory, the lack of an explicit systems theoretical framework selection in most studies reflects a gap in intervention design conceptualization.

Although, cultural components were a strength in the two studies reviewed, more evidence is needed to account for the particularities of the specific Latinx groups addressed, as well as how culture is considered beyond delivery language, focus on familismo and recruitment and implementation settings. These gaps could be addressed with a more intentional conceptual, systemic, and cultural lens design for psychosocial interventions.

Practice and Research Recommendations

Some promising intervention models like Abrazo and the photonovela have shown acceptability with Latinx populations, predominantly Mexican Americans (Casillas et al., 2021). They are examples of intervention design that consider the family as a unit and tailor both intervention and outcomes to Latinx participants within a research design. For example, Casillas et al. (2021) used participatory methods for integrating family members, researchers, and health care providers in their intervention design and implementation. We suggest that these methods could benefit cultural adaptation of cancer psychosocial interventions by utilizing perspectives from all the participants involved. Interventions should consider systemic components such as focusing on improving communication and relationships between family members, as well as addressing cancer life disruption and role shifts as topics addressed and worked on. All family members should be part of the interventions, with interventions focusing on dyads of patient and caregiver, or patient and spouse, or patient and child; multi-family members and co-survivors.

Research design of cancer psychosocial interventions could benefit from conceptualizing from a systems perspective to include both intervention components and outcomes that address the family as a unit. For quantitative studies, data analytic plans with individual measures can consider comparing outcomes between family members, and not only between family units intervened. Also, validating culturally sensitive instruments and testing in controlled trials with longitudinal follow-up would enhance research aimed at cultural adaptations. Research in general should be plurimethod, with qualitative designs to capture meaning and systemic process descriptions, and mixed methods to provide a conceptual and empirical integration between different kinds of data.

Conclusion

This critical review argued how the integration of systems theory and cultural considerations can address significant gaps in cancer family-based psychosocial interventions targeting Latinx populations from a theoretical and empirical basis. Cancer health disparities in the Latinx groups exist via several social determinants of health, and research on family psychosocial interventions has proven its effectiveness in reducing outcomes related to them. Despite this knowledge, family-based psychosocial intervention research still has considerable gaps. Nine family-based cancer psychosocial interventions selected for this review were able to demonstrate how systems theory components can be integrated in design, implementation, and evaluation of interventions. It also demonstrated in a few of them how cultural considerations can reduce accessibility gaps. Future directions in research of cancer family-based psychosocial interventions for Latinx should include cultural adaptations of effective interventions for the specific Latinx groups intended, as well as the use of mixed methods and qualitative methods for both intervention design and evaluation. Most notably, it is important to have a clinical theoretical framework guiding family psychosocial interventions for cancer. As Baquero and Parra-Medina (2020) stated,

we propose that research focuses first on theory development and model testing that adequately incorporate evidence-based, theory-based hypothesis and well-defined constructs that capture the experiences of Latinx persons. These constructs and models should be primarily based on historical, cultural, and socioeconomic experiences of Latinx persons and abandon attempts to adapt or interpret Latinx health behaviors based on theories and models developed from a white dominant perspective. (p. 38)

When it comes to culture, it’s important to go beyond stereotypical values associated with different ethnic/racial minorities (e.g., familismo, collectivism) and understand their varying manifestations (Llave et al., 2024). Combining a systems theory lens with a cultural framework offers a promising path toward designing and evaluating interventions that are both theoretically grounded and culturally relevant. While this review cannot establish that such interventions reduce cancer health disparities, the reviewed evidence points to their potential to reduce psychological distress, strengthen family communication and coping, and improve the accessibility and acceptability of psychosocial care for Latinx families affected by cancer. Realizing this potential will require research that directly tests these interventions in Latinx families.